Welcome to the first issue of Advocacy Brief, the monthly e-newsletter featuring advocacy and legislative updates related to dentistry. Previously, ASDA delivered this content to you via the Legislative Ledger. You'll notice that the name and look may be different, but we promise to continue to provide important and timely updates coming from Washington, D.C., and your state capitols to keep you informed on how issues may impact your future.

From Washington

What exactly is the "fiscal cliff"?

The term "fiscal cliff," coined by Federal Reserve Chairman Ben Bernanke and sensationalized by the media, is somewhat misleading. Some policy analysts have defined this issue as the "fiscal hill or slope," emphasizing the resulting economic environment will occur gradually, opposed to an abrupt financial disaster. Regardless of how it's classified, most agree any inaction to resolve this could lead to another recession.

The United States arrived at the "fiscal cliff" due to four specific tax measures that expired at the end of 2012:

The Economic Growth and Tax Relief Reconciliation Act of 2001 and the Jobs and Growth Tax Relief Reconciliation Act of 2003 (known as the Bush Tax Cuts): these cuts lowered both individual and investment income tax rates while expanding existing tax credits.

The American Recovery and Reinvestment Act of 2009 (known as the stimulus plan): this stimulus package expanded programs like the American Opportunity tax credit, which helps students pay for college.

The Payroll Tax Holiday: this reduced the payroll tax rate from 6.2% to 4.2% on employees.

The Alternative Minimum Tax: this tax was originally intended as a standard tax for the wealthy, however it has not been adjusted for inflation and would include many middle-class families

If these measures were to continue into the coming year, they would cost more than $440 billion. However, in addition to taxes, the "fiscal cliff" also includes spending cuts.

ASDA signed onto a letter from the American Dental Association (ADA) and others in organized dentistry to express support of the nutrition education provisions in H.R. 6083, the Federal Agriculture Reform and Risk Management Act of 2012. H.R. 6083 includes a provision that reauthorizes the Supplemental Nutrition Assistance Program (SNAP-Ed) through fiscal year 2017. The activities supported by SNAP-Ed help states provide nutrition education services to persons eligible for SNAP and improve the likelihood that eligible low-income individuals will make healthy food choices within a limited budget. This can (and often does) include promoting diets that are low in sugar (and acid) to help prevent tooth decay.

U.S. Department of Health and Human Services issues rules defining essential benefits based on a state-specific benchmark plan

On Nov. 20, 2012, the U.S. Department of Health and Human Services (HHS) published a proposed rule to assist in the implementation of the Affordable Care Act (ACA). The ACA sets forth that essential health benefits (EHB) be equal in scope to benefits by a typical employer plan. To meet this requirement in every state, the proposed rule defines EHB based on a state-specific benchmark plan. The rule proposes that states select a benchmark plan from among several options identified in the proposed rule. Essential health benefits must include items and services within at least 10 categories, including pediatric services, including oral and vision care.

Source: December 2012 ADEA State Update

New regulations impacting doctors of oral surgery and doctors of dental medicine

Although current Medicare regulations limit the ordering of portable x-ray services to a Doctor of Medicine (M.D.) or a Doctor of Osteopathy (D.O.), the Office of the Inspector General (OIG) in its December 2011 report entitled Questionable Billing Patterns of Portable X-Ray Suppliers (OEI-12-10-00190) found that Medicare was paying for portable x-ray services ordered by physicians other than M.D.s and D.O.s.

The U.S. Department of Health and Human Services (HHS) has issued a final rule with comment period revising current regulations, which limit ordering of portable x-ray services to only a M.D. or D.O., to allow other physicians and non-physician practitioners acting within the scope of their Medicare benefit and state law to order portable x-ray services. Specifically, HHS proposed revisions to the Medicare Conditions for Coverage (CfC) regulations at §486.106(a) and §486.106(b) permitting portable x-ray services to be ordered by a physician or non-physician practitioner in accordance with the ordering policies for other diagnostic services under §410.32(a).

This final rule (see federal regulation pages 69009-69012) would allow a M.D. or D.O., as well as a nurse practitioner, clinical nurse specialist, physician assistant, certified nurse-midwife, doctor of optometry, doctor of dental surgery, doctor of dental medicine, doctor of podiatric medicine, clinical psychologist, and clinical social worker to order portable x-ray services.

Source: December 2012 ADEA State Update

Dentist elected to Arkansas state legislature

On Jan. 14, 2013, the Regular Session of the 89th Arkansas General Assembly will convene and Deborah Ferguson will embark on a new journey as a State Representative in Arkansas. Dr. Ferguson, a Democrat, was raised in Parkin, Ark. She graduated from Parkin High School and holds a B.A. in Interior Design from the University of Mississippi. Dr. Ferguson graduated from the University of Tennessee Health Science Center College of Dentistry and worked as a dentist in West Memphis for 25 years. She has retired from her dental practice. Dr. Ferguson won the general election with 79.18% of the vote.

Source: December 2012 ADEA State Update

State Policy Updates

Illinois: H.B. 6246, introduced by State Representative Mary E. Flowers (D-IL), amends several policies affecting the oral health community. The bill provides that, subject to appropriation, the Department of Public Health shall administer a program for the education of specified non-dental medical professionals about oral health, with the goal of integrating oral health care into overall health care, and may make grants to, or enter into contracts with, specified public or nonprofit medical or educational entities to educate non-oral health professionals to promote oral health education. The bill also contains provisions concerning dental training residency programs, dental programs in schools, and emergency room care coordination. Additionally, the bill creates the Oral Health Professional Student Loan Fund as a special fund to provide student loans to oral health professional students, including dentists and dental hygienists. The bill has been referred to the House Rules Committee for consideration.

New Jersey: A.R. 111 introduced by State Assemblywoman Annette Quijano (D-NJ) and S.R. 56 introduced by State Senator Shirley Turner (D-NJ) each memorialize the state's request for the U.S. Congress to provide Medicare coverage for dentures, eyeglasses and hearing aids. AR 111 has been referred to the Assembly Committee on Health and Senior Services for consideration. SR 56 has been referred to the Senate Health, Human Services and Senior Citizens Committee for consideration